LAW
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Ohio Laws and Rules
(A) To be eligible for the Ohio’s best Rx program, an individual must meet all of the following requirements at the time of application for the program:
(1) The individual must be a resident of this state.
(2) One of the following must be the case:
(a) The individual has family income, as determined under rules adopted pursuant to section 173.83 of the Revised Code, that does not exceed three hundred per cent of the federal poverty guidelines, as revised annually by the United States department of health and human services in accordance with section 673(2) of the “Omnibus Budget Reconciliation Act of 1981,” 95 Stat. 511, 42 U.S.C. 9902, as amended;
(b) The individual is sixty years of age or older;
(c) The individual is a person with a disability, as defined in section 173.06 of the Revised Code.
(3) Except as provided in division (B) of this section, the individual must not have coverage for outpatient drugs paid for in whole or in part by any of the following:
(a) A third-party payer, including an employer;
(b) The medicaid program;
(c) The children’s health insurance program;
(d) The disability medical assistance program;
(e) Another health plan or pharmacy assistance program that uses state or federal funds to pay part or all of the cost of the individual’s outpatient drugs.
(4) The individual must not have had coverage for outpatient drugs paid for by any of the entities or programs specified in division (A)(3) of this section during any of the four months preceding the month in which the application for the Ohio’s best Rx program is made, unless any of the following applies:
(a) The individual is sixty years of age or older.
(b) The third-party payer, including an employer, that paid for the coverage filed for bankruptcy under federal bankruptcy laws.
(c) The individual is no longer eligible for coverage provided through a retirement plan subject to protection under the “Employee Retirement Income Security Act of 1974,” 88 Stat. 832, 29 U.S.C. 1001, as amended.
(d) The individual is no longer eligible for the medicaid program, children’s health insurance program, or disability medical assistance program.
(e) The individual is either temporarily or permanently discharged from employment due to a business reorganization.
(B) An individual is not subject to division (A)(3) of this section if the individual has coverage for outpatient drugs paid for in whole or in part by either of the following:
(1) The workers’ compensation program;
(2) A medicare prescription drug plan offered pursuant to the “Medicare Prescription Drug, Improvement, and Modernization Act of 2003,” 117 Stat. 2071, 42 U.S.C. 1395w-101, as amended, but only if all of the following are the case with respect to the particular drug being purchased through the Ohio’s best Rx program:
(a) The individual is responsible for the full cost of the drug.
(b) The drug is not subject to a rebate from the manufacturer under the individual’s medicare prescription drug plan.
(c) The manufacturer of the drug has agreed to the Ohio’s best Rx program’s inclusion of individuals who have coverage through a medicare prescription drug plan.
Effective Date: 07-01-2007